The Cardiovascular Management of the Critically Ill Patient

  • S. Magder
Part of the Update in Intensive Care and Emergency Medicine book series (UICM, volume 28)


Volume management is a major activity in the intensive care unit, because of the importance of blood volume as a determinant of venous return and cardiac output. The basic principles that I will discuss in this chapter can be summarized as there needs to be “enough but not too much” and “quantity must be differentiated from quality”. Cardiac output is dependent upon the interaction of two functions:circuit function (or venous return) and cardiac function [1,2]. I will begin by reviewing the basics for venous return.


Cardiac Output Venous Return Atrial Pressure Pleural Pressure Circuit Function 
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  1. Magder S (1992) Shock Physiology. In: Pinsky MR, Dhainault JF (eds) Physiological Foundations of Critical Care Medicine. Williams and Wilkins, Philadelphia, pp 140–160.Google Scholar
  2. Guyton AC, Jones CE, Coleman TG (1973) Circulatory physiology: cardiac output and its regulation. In: Guyton AC (ed), W. B. Saunders Co.Google Scholar
  3. Berne RM, Levy MN (1983) The cardiovascular system. In: Berne RM, Levy MN (eds) Physiology. Mosby, St. Louis, pp 439–638.Google Scholar
  4. Guyton AC (1955) Determination of cardiac output by equating venous return curves with cardiac response curves. Physiol Rev 35:123–129 (Abstract).PubMedGoogle Scholar
  5. Permuti S, Riley S (1963) Hemodynamics of collapsible vessels with tone: the vascular waterfall. J Appi Physiol 18 (5): 924–932.Google Scholar
  6. Vanelli G, Magder S (1996) Circuit factors in the high cardiac output of sepsis. J Crit Care (in press).Google Scholar
  7. Rothe CF (1983) Reflex control of veins and vascular capacitance. Physiol Rev 63 (4): 1281–1295.PubMedGoogle Scholar
  8. Magder S, De Varennes B, Ralley F (1994) Clinical death and the measurement of stressed vascular volume in humans. Am Rev Respir Dis 149: A1064 (Abstract).Google Scholar
  9. Deschamps A, Magder S (1992) Baroreflex control of regional capacitance and blood flow distribution with or without alpha adrenergic blockade. J Appi Physiol 263: H1755–H1763.Google Scholar
  10. Shoukas AA, Sagawa K (1973) Control of total systemic vascular capacity by the carotid sinus baroreceptor reflex. Circ Res 33:22–33.PubMedGoogle Scholar
  11. Appleton C,Olajos M, Morkin E, Goldman S (1985) Alpha-1 adrenergic control of the venous circulation in intact dogs. J Pharmacol Exp Ther 233:729–734.PubMedGoogle Scholar
  12. Manyari DE, Wang Z, Cohen J, Tyberg JV (1993) Assessment of human splachnic venous volume-pressure relation using radionuclide plethysmography. Circulation 87:1142–1151.PubMedGoogle Scholar
  13. Green JF, Jackman AP, Parsons G (1978) The effects of morphine on the mechanical properties of the systemic circulation in the dog. Circ Res 42 (4): 474–478.PubMedGoogle Scholar
  14. Bishop VS, Stone HL, Guyton AC (1964) Cardiac function curves in conscious dogs. Am J Physiol 207 (3): 677–682.PubMedGoogle Scholar
  15. Magder SA, Georgiadis G, Tuck C (1992) Respiratory variations in right atrial pressure predict response to fluid challenge. J Crit Care 7:76–85.CrossRefGoogle Scholar
  16. Wilson CR, Vanelli G, Magder S, Hussain SNA (1991) The effect of phrenic afferent stimulation by bradykinin on the distribution of ventilatory drive. Clin and Invest Med 14 (4): A112 (Abstract).Google Scholar
  17. Fessler HE, Brower RG, Wise RA, Permutt S (1992) Effects of positive end-expiratory pressure on the gradient for venous return. Am Rev Respir Dis 146:4–10.PubMedGoogle Scholar
  18. Fessler HE, Brower RG, Wise RA, Permutt S (1992) Effects of positive end-expiratory pressure on the gradient for venous return. Am Rev Respir Dis 143:19–24.Google Scholar
  19. Nanas S, Magder S (1992) Adaptations of the peripheral circulation to PEEP. Am Rev Respir Dis 146:688–693.PubMedGoogle Scholar
  20. Lemaire F, Teboul J-L, Cinotti L, et al. (1988) Acute left ventricular dysfunction during unsuccessful weaning from mechanical ventilation. Anesthesiology 69:171–179.PubMedCrossRefGoogle Scholar

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© Springer-Verlag Berlin Heidelberg 1997

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  • S. Magder

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